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Longmont United Hospital changes irk some patients

CEO: New rules regarding certain doctors a 'business decision'

By Magdalena WegrzynLongmont Times-Call

Posted:
11/17/2012 07:39:10 PM MST

Updated:
11/18/2012 06:11:11 PM MST

Josefa Mazzuca, 75, visits with her cardiologist Dr. Dan White on Tuesday at Rocky Mountain Cardiology, 2101 Ken Pratt Blvd. White and all other outside cardiologists stopped being allowed to treat patients at Longmont United Hospital in September. Instead, LUH has hired three cardiologists to work there exclusively: Linda Backup, John Stathis and Murry Drescher.
(
LEWIS GEYER
)

LONGMONT -- When Josefa Mazzuca called her cardiologist earlier this month for more nitroglycerin pills, her doctor detected distress in her voice and set up an appointment.

Turns out, the 75-year-old grandmother was in mild heart failure. She was prescribed a diuretic and followed up with the cardiologist, Dr. Daniel White, on Tuesday.

"He just talked to me on the phone and could tell something was going down," she said.

So when the Longmont woman learned that White can't see her -- or any other patients -- at Longmont United Hospital, she was upset.

"I'm 75 years old, and I've always had my doctors, and I intend to have them until I die," she said.

But White -- and all other outside cardiologists -- stopped being allowed to treat patients at LUH in September. Instead, LUH has hired three cardiologists to work there exclusively: Linda Backup, John Stathis and Murry Drescher.

"We decided that what would be best for our patients and what would be best for the hospital was to have a dedicated service for this institution, meaning that the cardiologists would not have to cover at other hospitals and that they would be dedicated to this hospital," said Mitch Carson, LUH's president and CEO.

The decision came more than a year after the practice that White belongs to, Rocky Mountain Cardiology, became employed by LUH's competitor, Boulder Community Hospital.

White and cardiologist Dr. Bryan Reynolds practice at Rocky Mountain Cardiology's Longmont office. Under the new arrangement, they won't be able to treat their patients even when they are admitted to LUH for an emergency. It's a move the cardiologists say jeopardizes the patient-physician relationships they have developed.

"It changes (patients') access to us if they end up in a hospital," Reynolds said. "That's damaging because in their moment of need, they're told their heart doctor can't see them."

Legally, Carson said, LUH does not have a way to allow outside cardiologists to see only their patients at the hospital. According to the hospital's bylaws, when a physician is an active member of the medical staff, they are required to be on-call, which allows them to receive new patients from the emergency room. In order words, Carson said, LUH cannot change the system to allow cardiologists to see one set of patients, but not another.

"To me, it's not really a clinical matter," Carson said. "It is a business matter. They made a business decision to be employed by a competing hospital. Nothing wrong with that. And then we made a business decision to strengthen our cardiology service and focus it on the hospital here."

Changing practices

Rocky Mountain Cardiology started in Boulder in the 1980s, and, for decades, physicians with the private practice served at hospitals throughout the county, including BCH and LUH.

"With the changing climate of healthcare and everything, it became incredibly difficult to run our practice," White said.

In July 2011, after two years of negotiations, BCH acquired Rocky Mountain Cardiology, employing its eight physicians, two nurse practitioners and one physician assistant.

A few weeks later, White and Reynolds received a letter from LUH's administration informing them that the lease on their office in an LUH medical building was terminated because the practice was sold to a competitor. The doctors and their nurse practitioner relocated to an office on Ken Pratt Boulevard in December, and continued to treat patients at LUH.

Both White and Reynolds deny that they shifted business to Boulder. BCH spokesman Rich Sheehan said the hospital's stance is "that a physician should always do what's in the best interest of their patients" and BCH does not dictate at which facility physicians should treat patients.

A growing trend

Physicians shifting out of private practice and into employment situations is nothing new.

From 2000 to 2010, the number of physicians employed by hospitals rose more than 35 percent, from 160,000 to 212,000, according to the American Hospital Association. Within the next five years, the Colorado Hospital Association estimates that up to 90 percent of physicians in the state will be employed by hospitals, health plans or large multi-specialty physician practices.

"We're well beyond this being a new, emerging trend," said Steven Summer, president and CEO of the Colorado Hospital Association.

Young physicians aren't as likely to go into private practice, which is more expensive and time-consuming, and leaves less time for treating patients. Rather, they prefer to find employment at a hospital, where someone else deals with Medicare and Medicaid reimbursements, insurance companies and other business issues.

The Affordable Care Act has precipitated that shift, Summer said. A section of the act penalizes hospitals for re-admissions within 30 days of a discharge by lowering Medicare payments. Hospitals often have more programs and staff to address re-admissions than private practices do.

While an uptick in physician employment has already happened at many Denver-area hospitals, it has taken longer to reach LUH and BCH, Boulder County's two freestanding, nonprofit hospitals.

"In our case, it was really partially driven by who we were recruiting and that our recruitment has really stepped up in the last few years because our medical staff, like many, are getting to the point where some of them are going to start retiring, so we're going to have to start replacing them," Carson said. "And, quite frankly, that's when many of the doctors found they couldn't find somebody to come in and take over their practice."

LUH has exclusive arrangement that bar outside physicians from treating patients at its hospital with several departments, including radiology, pathology, anesthesiology, pulmonary medicine, emergency services and, of course, cardiology. Much like the situation with Rocky Mountain Cardiology, when physicians at Frontier Internal Medicine become Boulder Community Hospital employees on June 1, they could no longer treat patients at LUH.

'I want my doctors'

Mazzuca, the 75-year-old grandmother, is determined to stick with her cardiologist. Her relatives have been given strict instructions to take her to Boulder Community Hospital if possible, even though she lives two blocks from LUH's campus on Mountain View Avenue.

"When they take me in, I will tell the ambulance and I will tell my family, 'They are to stabilize me and then you are to take me to Boulder Community Hospital,'" she said. "I will tell my family and they will do as I say. I will not stay there. ... I want my doctors."

That creates another set of problems. In an emergency situation, patients should be treated at the nearest hospital, but changes in the cardiology department have prompted some Longmont patients to "risk it" and drive to Boulder to make sure they can see their doctors, said Anne Waugaman, a nurse practitioner with Rocky Mountain Cardiology.

"We even had a patient's husband call us after he called 911 because his wife was having chest pain," Waugaman wrote in an email. "He wanted Dr. White to tell the paramedics to bring her to BCH, which of course he didn't do. Luckily, she wasn't having a heart attack."

Longmont resident Jo Silkensen, a patient of Rocky Mountain Cardiology for more than a decade, said she has written letters to LUH administration expressing her displeasure with the changes, which she sees as a step backwards. She wants to see White and Reynolds be allowed to practice at LUH -- even if only for an trial period.

"At this point in my life, and with my history with them, I have no desire to establish a new relationship with a new set of doctors," she said. "Plus, I live six blocks from (LUH)."

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